Significance Of Simultaneous Measurement Of Platelet Spe-cific Autoantibody, Reticulated Platelet And TPO In The Diagnosis Of Immune Thrombocytopenia

Objective: To investigate the diagnosis value of platelet glycoprotein specific autoantibody, reticulated platelet(RP) and thrombopoietin(TPO) in the patients with immune thrombocytopenia (ITP).Methods: Platelet glycoprotein specific autoantibodies were detected through a test called modified monoclonal antibody immobilization of platelet antigens assay (modified MAIPA), using monoclonal antibodies specific for glycoproteins(GP)Ⅱb/Ⅲa andⅠb/Ⅸin 90 patients with ITP and 20 patients with nonimmune thrombocytopenia(NITP); RP% were measured by flow cytometry(FCM) and the plasma levels of TPO were detected by enzyme-linked immunosorbent assay(ELISA) in those patients.Resultes: 1. In 90 patients with ITP, the positive rate of single anti-GPⅡb/Ⅲa was 8.89%, of single anti-GPⅠb/Ⅸwas 12.22%, of the both two autoantibodies was 33.33%, the total positive rate of antiplatelet membrane glycoprotein autoantibody was 54.44%. The positive rate in new-onset patients was 57.14%, and in recurrent patients was 44.44%; before treatment was 58.46%, after glucocorticoid treatment was 40%; in patients with PLT≤30×10~9/L was 58.18%, and in patients with PLT>30×10~9/L was 48.57%.2. 86.67% of the 90 ITP patients had high levels of RP%. Compared with the normal group, there was a significant difference (P < 0.05). 90.90% of the 90 ITP patients had high levels of RP% before treatment, 75% after glucocorticoid treatment, there was a significant difference (P<0.05). There was no significant difference between the NITP group and the normal group (P>0.05). 3. There was no significant difference in the levels of TPO between ITP patients and normal control group (P>0.05). There was a significant difference in the levels of TPO between NITP patients and normal control group (P<0.05).4. The 90 patients were detected simultaneously by MAIPA and RP%, the positive rate of MAIPA was 54.44% and for RP% was 86.67%. The positive proportion of the both two experiments were 47.78%.Conclusions:1. Detection of platelet-specific autoantibodies by MAIPA had high specificity for ITP diagnosis, but low sensitivity. When combined two specific autoantibodies, the sensitivity increased. Admini- stration of glucocorticoid effected the positive rate of anti-GPⅡb/Ⅲa and anti-GPⅠb/Ⅸ. To increase the positive rate, specific autoantibodies should be detected before the glucocorticoid treatment.2. Detection of reticulated platelets had high sensitivity for ITP diagnosis. The positive rate of reticulated platelets was decreased after glucocorticoid treatment.3. Detection of TPO level could help to distinguish the different reasons of the thrombocytopenia.4. The combined tests of platelet glycoprotein specific autoantibody assay, RP% and the level of TPO would be effective indicators for diagnosis of ITP, which may improve sensitivity, specificity and accuracy of the diagnosis of ITP.